Atherapy ormedical treatment is the attempted remediation of ahealth problem, usually following amedical diagnosis. Both words,treatment andtherapy, are often abbreviatedtx,Tx, orTx.
Treatment andtherapy are often synonymous, especially in the usage ofhealth professionals. However, in the context ofmental health, the termtherapy may refer specifically topsychotherapy.
The wordscare,therapy,treatment, andintervention overlap in asemantic field, and thus they can besynonymous depending oncontext. Moving rightward through that order, the connotative level ofholism decreases and the level of specificity (toconcrete instances) increases. Thus, inhealth-care contexts (where its senses are alwaysnoncount), the wordcare tends to imply a broad idea of everything done to protect or improve someone's health (for example, as in the termspreventive care andprimary care, which connote ongoing action), although it sometimes implies a narrower idea (for example, in the simplest cases ofwound care or postanesthesia care, a few particular steps are sufficient, and the patient's interaction with the provider of such care is soon finished). In contrast, the wordintervention tends to be specific and concrete, and thus the word is often countable; for example, one instance ofcardiac catheterization is one intervention performed, and coronary care (noncount) can require a series of interventions (count). At the extreme, the piling on of such countable interventions amounts to interventionism, a flawed model of care lacking holistic circumspection—merely treatingdiscrete problems (in billable increments) rather than maintaining health.Therapy andtreatment, in the middle of the semantic field, can connote either the holism ofcare or the discreteness ofintervention, with context conveying the intent in each use. Accordingly, they can be used in both noncount and count senses (for example,therapy forchronic kidney disease can involve several dialysis treatments per week).
The wordsaceology andiamatology are obscure and obsolete synonyms referring to the study of therapies.
The English wordtherapy comes via Latintherapīa fromAncient Greek:θεραπεία and literally means "curing" or "healing".[1] The termtherapeusis is a somewhat archaic doublet of the wordtherapy.
Therapy as a treatment for physical or mental condition is based on knowledge usually from one of three separate fields (or a combination of them): conventional medicine (allopathic, Western biomedicine, relying on scientific approach and evidence-based practice), traditional medicine (age-old cultural practices), and alternative medicine (healthcare procedures "not readily integrated into the dominant healthcare model").[2]
Levels of care classifyhealth care into categories of chronology, priority, or intensity, as follows:
Urgent care handles health issues that need to be handled today but are not necessarily emergencies; the urgent care venue can send a patient to the emergency care level if it turns out to be needed.
In the United States (and possibly various other countries),urgent care centers also serve another function as their other main purpose: U.S.primary care practices have evolved in recent decades into a configuration whereby urgent care centers provide portions of primary care that cannot wait a month, because getting an appointment with the primary care practitioner is often subject to a waitlist of 2 to 8 weeks.[3]
Emergency care handlesmedical emergencies and is a first point of contact or intake for less serious problems, which can be referred to other levels of care as appropriate. This therapy is often given to patients before a definitive diagnosis is made.[4]
Intensive care, also calledcritical care, is care for extremely ill or injured patients. It thus requires high resource intensity, knowledge, and skill, as well as quickdecision making.
Ambulatory care is care provided on anoutpatient basis. Typically patients can walk into and out of the clinic under their own power (hence "ambulatory"), usually on the same day. This care type also involves surgery which, according to recent research, offers "generally superior 30-day outcomes relative to inpatient-based care”.[5]
Home care is care at home, including care from providers (such as physicians, nurses, and home health aides) makinghouse calls, care fromcaregivers such as family members, and patientself-care.
Primary care is meant to be the main kind of care in general, and ideally amedical home that unifies care across referred providers. The current trend in this area is digitalization aiming to ensure open access to information about therapy, issues, and recent progress on biomedical research.[6]
Secondary care is care provided by medical specialists and other health professionals who generally do not have first contact with patients, for example,cardiologists,urologists anddermatologists. A patient reaches secondary care as a next step fromprimary care, typically by provider referral although sometimes by patient self-initiative. According to a systematic review, fields for development secondary care from patients’ viewpoint may be classified into four domains that should usefully guide future improvement of this care stage: “barriers to care, communication, coordination, and relationships and personal value”.[7]
Tertiary care is specialized consultative care, usually forinpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as atertiary referral hospital.
Follow-up care is additional care during or afterconvalescence. Aftercare is generally synonymous with follow-up care. One of the key areas of development–Telehealth, including non-clinical services: provider training, administrative meetings, and continuing medical education–offers opportunities to improve access to care, increase provider and patient productivity through reduced travel, potential expenses savings, and the ability to expand services.[8]
End-of-life care is care near the end of one's life. It often includes the following:
Hospice care is palliative care very near the end of life whencure is very unlikely. Its main goal is comfort, both physical and mental. A systematic meta review showed that the most cost-efficient one relates to home-based end-of-life care, including reduced overall "resource use and improved patient and carer outcomes”.[9]
Treatment decisions often follow formal or informalalgorithmic guidelines. Treatment options can often be ranked or prioritized intolines of therapy:first-line therapy,second-line therapy,third-line therapy, and so on.First-line therapy (sometimes referred to asinduction therapy,primary therapy, orfront-line therapy)[10] is the first therapy that will be tried. Its priority over other options is usually either: (1) formally recommended on the basis ofclinical trial evidence for its best-available combination of efficacy, safety, and tolerability or (2) chosen based on the clinical experience of the physician. If a first-line therapy either fails to resolve the issue or produces intolerableside effects, additional (second-line) therapies may be substituted or added to the treatment regimen, followed by third-line therapies, and so on.
An example of a context in which the formalization of treatment algorithms and the ranking of lines of therapy is very extensive ischemotherapy regimens. Because of the great difficulty in successfully treating some forms of cancer, one line after another may be tried. Inoncology the count of therapy lines may reach 10 or even 20.
Often multiple therapies may be tried simultaneously (combination therapy or polytherapy). Thuscombination chemotherapy is also called polychemotherapy, whereas chemotherapy with one agent at a time is called single-agent therapy or monotherapy. Single-agent therapy is a care algorithm that focuses on one specific drug or procedure. It utilizes a single therapeutic agent rather than combining multiple ones.[11] Multiagent Therapy is a treatment by two or more drugs or procedures. Comprehensive therapy combines various forms of medical treatment to provide the most effective care for patients.[12]
Adjuvant therapy is therapy given in addition to the primary, main, or initial treatment, but simultaneously (as opposed to second-line therapy).Neoadjuvant therapy is therapy that is begun before the main therapy. Thus one can consider surgical excision of a tumor as the first-line therapy for a certain type and stage of cancer even though radiotherapy is used before it; the radiotherapy is neoadjuvant (chronologically first but not primary in the sense of the main event).Premedication is conceptually not far from this, but the words are not interchangeable; cytotoxic drugs to put a tumor "on the ropes" before surgery delivers the "knockout punch" are called neoadjuvant chemotherapy, not premedication, whereas things like anesthetics or prophylactic antibiotics before dental surgery are called premedication.
Step therapy or stepladder therapy is a specific type of prioritization by lines of therapy. It is controversial inAmerican health care because unlike conventionaldecision-making about what constitutes first-line, second-line, and third-line therapy, which in the U.S. reflects safety and efficacy first and cost only according to the patient's wishes, step therapy attempts to mix cost containment by someone other than the patient (third-party payers) into the algorithm.
Therapy freedom refers to prescription for use of an unlicensed medicine (without a marketing authorization issued by the licensing authority of the country)[13] and the negotiation betweenindividual and group rights are involved. A comprehensive research in Australia, Czech Republic, India, Israel, Italy, Netherlands, Spain, Serbia, Sweden, UK, and USA showed that the rate of the unlicensed medicine prescription has been reported to range from 0.3 to 35% depending on the country.[13] In many jurisdictions, therapy freedom is limited to cases of no treatment existing that is both well-established and more efficacious.[14]
A therapy that is intended to stop a medical condition from progressing any further. A medication taken at the earliest signs of a disease, such as ananalgesic taken at the first symptoms of amigraine headache to prevent it from getting worse, is an abortive therapy. Compareabortifacients, which abort a pregnancy.
A therapy thatfiguratively provides a bridge to another step or phase, crossing over some immediate chasm (challenge), in contrast withdestination therapy, which is the final therapy in cases where clinically appropriate.
consolidation therapy
A therapy given to consolidate the gains frominduction therapy. In cancer, this means chasing after any malignant cells that may be left.
curative therapy
A therapy withcurative intent, that is, one that seeks tocure the root cause of a disorder. (also called etiotropic therapy)
definitive therapy
A therapy that may be final, superior to others,curative, or all of those.
A therapy that is the final destination rather than abridge to another therapy. Usually refers toventricular assist devices to keep the existing heart going, not just untilheart transplantation can occur, but for the rest of the patient's life expectancy.
A therapy given on an empiric basis; that is, one given according to a clinician's educated guess despite uncertainty about the illness's causative factors. For example, empiric antibiotic therapy administers abroad-spectrum antibiotic immediately on the basis of a good chance (given the history, physical examination findings, and risk factors present) that the illness is bacterial and will respond to that drug (even though the bacterial species or variant is not yet known).
Anexperimental therapy. Use of experimental therapies must be ethically justified, because by definition they raise the question ofstandard of care. Physicians have autonomy to provide empirical care (such asoff-label care) according to their experience and clinical judgment, but the autonomy has limits that precludequackery. Thus it may be necessary to design aclinical trial around the new therapy and to use the therapy only per a formalprotocol. Sometimes shorthand phrases such as "treated on protocol" imply not just "treated according to a plan" but specifically "treated with investigational therapy".
A therapy that is intended toprevent a medical condition from occurring (also called prophylaxis). For example, manyvaccines prevent infectious diseases.
A therapy tried after others have failed; it may be a "last-line" therapy.
stepdown therapy
Therapy that tapers the dosage gradually rather than abruptly cutting it off. For example, a switch from intravenous to oral antibiotics as an infection is brought under control steps down the intensity of therapy.
supportive therapy
A therapy that does not treat or improve the underlying condition, but rather increases the patient's comfort, also calledsymptomatic treatment (see there for more information).[15] For example, supportive care for flu, colds, or gastrointestinal upset can include rest, fluids, andover-the-counter pain relievers; those things do not treat the cause, but they treat the symptoms and thus provide relief. Supportive therapy may be palliative therapy (palliative care). The two terms are sometimes synonymous, but palliative care often specifically refers to serious illness andend-of-life care. Therapy may be categorized as havingcurative intent (when it is possible to eliminate the disease) orpalliative intent (when eliminating the disease is impossible and the focus shifts to minimizing the distress that it causes). The two are oftencontradistinguished (mutually exclusive) in some contexts (such as themanagement of some cancers), but they are not inherently mutually exclusive; often therapy can be both curative and palliative simultaneously.Supportive psychotherapy aims to support the patient by alleviating the worst of the symptoms, with the expectation thatdefinitive therapy can follow later if possible.
systemic therapy
A therapy that issystemic. In the physiologicalsense, this means affecting the whole body (rather than being local or locoregional), whether viasystemic administration, systemic effect, or both.Systemic therapy in the psychotherapeutic sense seeks to address people not only on the individual level but also as people in relationships, dealing with the interactions of groups.
Invasive therapy is achieved either through surgery or through the use of drugs.[16] Medical invasive treatments can be divided into two main categories: pharmacotherapy and surgery.[17]
Noninvasive therapies are medical treatments that do not involve entry into the body. It can be classified into five main categories: neurotherapy, physical therapy, occupational therapy, radiation therapy, and psychotherapy.[18]
by natural dry salt air: "taking the cure" indesert locales (especially common in prescientific medicine; for example, one 19th-century way to treat tuberculosis)
^Eskinazi, D., & Mindes, J. (2001). "Alternative medicine: definition, scope and challenges".Asia-Pacific Biotech News, 5(01), 19-25.
^Buttorff, C., Heins, S.E. & Al-Ibrahim, H. Comparison of definitions for identifying urgent care centers in health insurance claims. Health Serv Outcomes Res Method 21, 229–237 (2021).https://doi.org/10.1007/s10742-020-00224-6
^Hansoti, B., Aluisio, A. R., Barry, M. A., Davey, K., Lentz, B. A., Modi, P., ... & Global Emergency Medicine Think Tank Clinical Research Working Group. (2017). Global health and emergency care: defining clinical research priorities. Academic Emergency Medicine, 24(6), 742-753.
^Friedlander, David F. MD, MPH∗,†; Krimphove, Marieke J. MD; Cole, Alexander P. MD∗; Marchese, Maya MS∗; Lipsitz, Stuart R. ScD; Weissman, Joel S. PhD; Schoenfeld, Andrew J. MD, MSc; Ortega, Gezzer MD, MPH; Trinh, Quoc-Dien MD. Where Is the Value in Ambulatory Versus Inpatient Surgery?. Annals of Surgery 273(5):p 909-916, May 2021. | DOI: 10.1097/SLA.0000000000003578
^Maksut Senbekov, Timur Saliev, Zhanar Bukeyeva, Aigul Almabayeva, Marina Zhanaliyeva, Nazym Aitenova, Yerzhan Toishibekov, Ildar Fakhradiyev. (2020) The Recent Progress and Applications of Digital Technologies in Healthcare: A Review. International Journal of Telemedicine and Applications, Volume 2020, Issue 1.https://doi.org/10.1155/2020/8830200
^Sampson R, Cooper J, Barbour R, et al (2015). "Patients’ perspectives on the medical primary–secondary care interface: systematic review and synthesis of qualitative research."BMJ Open 2015;5:e008708. doi: 10.1136/bmjopen-2015-008708
^Snoswell CL, Taylor ML, Comans TA, Smith AC, Gray LC, Caffery LJ. (2020) "Determining if Telehealth Can Reduce Health System Costs: Scoping Review".J Med Internet Res 2020;22(10):e17298 doi: 10.2196/17298
^Luta, X., Ottino, B., Hall, P. et al. (2021) "Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews".BMC Palliat Care 20, 89.https://doi.org/10.1186/s12904-021-00782-7
^abGore RK, Chugh PD, Tripathi C, Lhamo Y, Gautam S. (2017). "Pediatric off-label and unlicensed drug use and its implications".Current clinical pharmacology, 12(1), 18-25.https://doi.org/10.2174/1574884712666170317161935
^Cousins S, Blencowe NS, Blazeby JM. (2019) What is an invasive procedure? A definition to inform study design, evidence synthesis and research tracking. BMJ Open. 2019 Jul 30;9(7):e028576. doi: 10.1136/bmjopen-2018-028576.
^Klein E. What does it mean to call a medical device invasive? Med Health Care Philos. (2023) Sep;26(3):325-334. doi: 10.1007/s11019-023-10147-x.
^Davis NJ, van Koningsbruggen MG. (2013) "Non-invasive" brain stimulation is not non-invasive. Front Syst Neurosci. 2013 Dec 23;7:76. doi: 10.3389/fnsys.2013.00076.
^Minkel, Jared D.; Krystal, Andrew D.; Benca, Ruth M. (2017)."Unipolar Major Depression". In Kryger, Meir; Roth, Thomas; Dement, William C. (eds.).Principles and Practice of Sleep Medicine (6th ed.). Philadelphia, PA: Elsevier. pp. 1352–1362.ISBN978-0-323-24288-2. Retrieved12 May 2021.
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